Systems and methods for wireless prescription compliance monitoring

ABSTRACT

A medical information system informs prescribers of prescription compliance information in a system for preparing a prescription. The point of prescribing messaging system can assist physicians in understanding prescription compliance when prescribing medication for patients by reviewing pertinent compliance data displayed with the apparatus such as filling dates, dosage and supply information, etc. The system may include a point of prescription application configured to access, either locally or remotely, compliance data typically generated from a pharmacy system. Prescription filling data and supply/dosage information may be compared to generate automated alerts to a physician or prescriber to identify over use, under use, compliance or non-compliance situations based on the accessed and compared data or otherwise identify differences between prescribed medication information and filled medication information.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part application of pending U.S.patent application Ser. No. 10/951,212, filed Sep. 27, 2004, and claimsthe benefit of the filing date of U.S. Provisional Patent ApplicationNo. 60/506,698 filed Sep. 26, 2003, the disclosures of which are herebyincorporated herein by reference.

BACKGROUND OF THE INVENTION

The method by which a patient fills a prescription written by his or herdoctor has become increasingly complex in the modern health careenvironment. Most patients with medical insurance must deal with ahealth care system having four components: an insurer, a physician whois enrolled in the insurer's network, service providers such aspharmacies, hospitals, etc., and the pharmacy benefit manager (PBM)—amanagement company that manages the pharmacy benefits of the insurer.

The PBM compiles a formulary of medications for the insurer (i.e., alist of medications that the insurer will cover for their enrolledmembers or that they prefer their members to use for given diagnosis.)In addition, the PBM maintains patient medication histories and otherpertinent information related to the safety of the formulary medicationsfor each member. Each PBM is electronically connected to the majority ofpharmacies in the nation.

When a prescription is presented at a pharmacy, the pharmacy computerconnects to the PBM that manages the pharmacy benefits for that patient.The PBM provides data such as eligibility information, plan details,co-payment requirements and generic options to the inquiring pharmacy.Additionally, the PBM checks to see whether the prescribed medication iswithin the benefit plan's formulary, and executes a Drug UtilizationReview (DUR), which analyzes the prescribed medication versus thepatient's known medication and medical history (drug to drug, drug toallergy, drug to medical condition, etc.)

A number of problems can occur during this process if the PBM detects aconflict or potential conflict with the presented script. Formularyvariance or contraindication will cause the PMB to signal a notificationto the pharmacist. Usually, the pharmacist will make one or more phonecalls to the physician to request a change in the prescription in orderto make it compliant with the plan, or consistent with the DURnotification. The pharmacist will speak directly to the physician torequest any changes being made to the prescription, and any changes areusually entered into the patient's chart. Thus, the current prescriptiondelivery system is increasingly hampered by escalating numbers ofnecessary phone calls to resolve these prescription-related issues, eachof which encroaches on both the pharmacist's and the physician's time.

One attempt to improve the prescription process requires installingcustom prescription management software on a local computer within aphysician's office, which has the capability of communicating with aremote PBM computer. A physician enters a prescription on a patient'schart, and gives the chart to a staff member (the “user”) who enters theprescription information on one or more data entry screens on the localcomputer. The software directs the local system to connect with the PBMto determine formulary compliance and to perform a DUR. Any problemswith the prescription are conveyed to the user, who must thencommunicate the difficulty to the physician. The physician alters theprescription, and the user repeats the process until an acceptableprescription is found.

Though this approach does reduce the previously requiredphysician-directed phone calls, it still causes considerable disruption.Each time the system indicates a problem, which may occur several timesfor a single prescription, the user must leave the computer, find andinterrupt the physician, and ask that changes be made. It is primarilyfor this reason that such a system has not been overwhelmingly adopted.

Such systems also do not provide sufficient means for informingprescribers about medications (new or otherwise) that may beappropriately used by their patients for any given problem whenprescribing or about the patient's compliance with past prescriptions.Traditionally, physicians become aware of potential alternativemedications in various ways. Drug sponsors often send salesrepresentatives to meet with prescribers or otherwise send literature toinform them about new medications and treatments. However, such methodstend to inundate prescribers with too much information relating to toomany different medications such that the volume of information rendersthe presentation of information for any individual drug ineffective.Moreover, such information may be presented at inopportune times whenthe prescriber is not prepared to consider the new drug information orsimply is unable to schedule a meeting with a particular representative.It may be desirable to have improvements to these systems for informingprescribers of medicines and alternatives thereto in an electronicprescribing environment while avoiding problems that may result frommedication conflicts indicated by a DUR and/or the requirements of apatient or plan specific formulary.

SUMMARY OF THE INVENTION

The invention relates to an automated system for assisting physicians.Generally, the system automatically displays patient prescriptioncompliance information for purposes of informing the prescriber ofpatient prescription compliance. In one aspect, a system for generatingelectronic prescriptions utilizes a method for informing the prescriberabout a patient prescription compliance information. The method mayincludes steps of receiving an indicator of a medication to beprescribed to a patient and accessing prescription compliance data ofthe patient. Additional steps may include prompting for a response toindicate whether or not the medication of the indicator should beprescribed to the patient and generating a prescription for the patientin response to the prompting. Preferably, the prescription compliancedata comprises a filling date and quantity and the quantity mayoptionally be a function of time. The system may generate a message todisplaying patient compliance data, which may include an alertcontaining an analysis of compliance data. Optionally, an automaticcomparison of compliance data may be implemented to select a compliancealert for conveying to the presciber underuse, overuse, non-use andproper use by the patient. The comparison may optionally compare filledmedication data and prescribed medication data to determine differencesbetween the data.

In another aspect, a method of presenting patient prescriptioncompliance data to a prescriber in a drug prescription system mayinclude maintaining data of patient prescription compliance information.A prescription application is provided configured for accepting a drugidentifier input request and for electronically generating aprescription with the drug identifier input request. The prescriptionapplication is further configured for accessing data of patientprescription compliance information, and for controlling presenting theprescription compliance information for display to the prescriber. Themay also be configured to generate a message containing an analysis ofcompliance data and optionally, for automatically comparing compliancedata to select a compliance alert.

In another aspect, an apparatus for generating electronic prescriptionsand informing prescribers of medication compliance information includesa user interface for accepting medication selections for inclusion in anelectronic prescription. The apparatus has a messaging controller fordisplaying patient compliance information associated with a priorprescription. Preferably, the apparatus also includes a prescriptiongenerator configured for forming a new electronic prescription with themedication. The apparatus preferably is configured to generate a messagecontaining an analysis of the patient compliance information, which maybe based on an automated analysis comparing the patient complianceinformation to select a compliance message, which may convey informationon over use, under use, non-use or proper use.

In one version, a system for generating electronic prescriptions andinforming prescribers of prescription medication compliance informationincludes a means for maintaining a data structure with patientprescription compliance information comprising prescribed medicationdata and filled medication data. Additional means for accessing thepatient compliance information from the data structure by the prescribermay also be included in the system, along with a means for presenting amessage informing of patient prescription compliance information to theprescriber. The system may also include means for selecting a first drugselection for a prescription by the prescriber and means for permittingthe prescriber to generate the prescription. The filled medication datacan include filling dates and quantities. The message may containfilling dates and/or an analysis of the patient compliance information.The analysis may be based from an automated means for comparing patientcompliance information that selects a compliance message on usage orcompliance. Preferably, the system may also include an automated meansfor determining a difference between prescribed medication data andfilled medication data and a message is generated to convey thedifference(s) to the prescriber.

Additional aspects of the invention will be apparent from a review ofthe drawings, the following disclosure, and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a network diagram of an example embodiment including preferredcomponents of a physician assist system of the invention including apoint of prescription application;

FIG. 2 is an representation of a preferred point of prescriptionmessaging application in a prescribing device with data associationsbetween trigger medications and sponsor messages;

FIG. 3 is a user interface of a point of prescription applicationillustrating a prescriber login to a physician assist system of theinvention;

FIG. 4 is a the user interface of FIG. 3 after entry of username andpassword;

FIG. 5 is a signature input user interface of a point of prescriptionapplication corresponding to the login procedure of the physician assistsystem of the invention;

FIG. 6 is a further login screen of a point of prescription applicationused in authorizing electronic prescribing of drugs in the physicianassist system of the invention;

FIG. 7 is a menu user interface of a point of prescription applicationwith icons for providing access to prescribing and alternativemedication suggesting routines of the invention;

FIG. 8 is a patient list user interface of a point of prescriptionapplication for whom medications may be prescribed according to aselection of an alternative medication suggestion of the invention;

FIG. 9 is another patient list user interface of a point of prescriptionapplication for whom medications may be prescribed according to aselection of an alternative medication suggestion of the invention;

FIG. 10 is a prescription history list user interface showing variouspast prescriptions of a point of prescription application with actionicons for performing DUR functions and accessing drug information;

FIG. 11 is a prescription description user interface of a point ofprescription application showing one prescription from the prescriptionhistory list of the user interface of FIG. 10 with action icons forperforming DUR functions, accessing PBM history, accessing prescriptioncompliance information and requesting drug information;

FIG. 11A illustrates a user interface display of prescription complianceinformation displayed in response to activation of the compliance iconIC of the user interface of FIG. 11 showing patient under use of anexample prescription;

FIG. 11B illustrates a user interface display of prescription complianceinformation displayed in response to activation of the compliance iconIC of the user interface of FIG. 11 showing patient over use of anexample prescription;

FIG. 11C illustrates a user interface display of prescription complianceinformation displayed in response to activation of the compliance iconIC of the user interface of FIG. 11 showing patient noncompliance withan example prescription;

FIG. 11D illustrates a user interface display of prescription complianceinformation displayed in response to activation of the compliance iconIC of the user interface of FIG. 11 showing patient compliance with anexample prescription;

FIG. 11E illustrates a user interface display of prescription complianceinformation displayed in response to activation of the compliance iconIC of the user interface of FIG. 11 showing patient compliance with anexample prescription and a warning of a difference between filled andprescribed information;

FIG. 12 is a search user interface of a point of prescriptionapplication for accessing information concerning particular brands ofmedications;

FIG. 13 is a drug information user interface of a point of prescriptionapplication for displaying information about a selected drug searched bythe interface of FIG. 12;

FIG. 14 is a medication selection user interface of a point ofprescription application for selecting a medication to generate anelectronic prescription for a patient;

FIG. 15 illustrates an automated DUR alert from the user interface ofFIG. 14 upon selection of a medication with the user interface of FIG.14;

FIG. 16 illustrates presenting of further DUR information concerning thealert of FIG. 15 in the point of prescription application;

FIG. 17 illustrates presenting of still further DUR informationconcerning the alert of FIG. 15 in the point of prescriptionapplication;

FIG. 18 illustrates a user interface of a point of prescriptionapplication with automated display of sponsor messages concerningalternative suggested medications associated with a selected medication,displayed in response to the selected medication, with action items forinitiating functionality of selecting the original selected medicationor a suggested alternative medication;

FIG. 19 illustrates selection of the action item initiating thefunctionality of selecting an alternative suggested medication in theuser interface of a point of prescription application of FIG. 18;

FIG. 20 illustrates a user interface of a point of prescriptionapplication showing further messages associated with the alternativesuggested medication including several dose and usage instructions forthe alternative suggested medication, also with action items forinitiating of access to drug information for or performing a DUR withthe alternative suggested medication;

FIG. 21 is the user interface of FIG. 20, illustrates activation of anext icon for initiation functionality of completing selecting thealternative suggested medication with a default dose and usageinstruction for an electronic prescription;

FIG. 22 is a user interface of a point of prescription application inresponse to the selection from the user interface of FIG. 21, displayingaction items for finalizing an electronic prescription;

FIG. 23 is an illustrated table data structure assessable to the pointof prescription application with associated selected or triggermedications and target or alternative suggested medications of differentbrands or generic names of various different sponsors (e.g., A, B andC); and

FIG. 24 is another example table data structure assessable by the pointof prescription application with associations between trigger and targetmedications also illustrating additional conditions for displayingmessages concerning the target medications.

DETAILED DESCRIPTION

Referring to the figures, where like numerals indicate similar features,a physician assist system 2 for electronic prescribing of the inventiontypically includes a prescribing device(s) 4, preferably accessible to aphysician, such as a desktop 4 a, laptop 4 b, hand held or palm computer4 c, a personal data assistant (PDA) 4 d or other programmableinput/output processing device such as a smart mobile phone 4 e. Thephysician assessable prescribing device 4 may optionally be configuredfor connection or networking to other systems or computers via one ormore communications mechanisms. While such communication links may inpart be implemented as a physical connection such as a telephone line,cable or contact based (e.g., cradle) hook-up, in a preferredembodiment, the prescribing device 4 at least includes a communicationsmechanism that can link the device to other systems via a wirelesscommunications channel. For example, the device may be configured forBluetooth networking and/or communications over a cellular telephonenetwork for transmitting data or voice. Where such networkedcommunications involve transfer of signals or messages over one or morenetwork(s) 6 that includes an open-type network, such as an internet orthe Internet, preferably such signals or messages are encrypted. Thenetwork(s) 6 may also include a telephone network, for example, in theevent that facsimile transmissions are utilized in the transmission ofprescription related messages as discussed in more detail herein.

As illustrated in FIG. 2, the physician accessible prescribing device 4generally includes a processor and memory with processor controlinstructions and/or other application specific electronic controlcircuitry. Preferably, such components are for implementingfunctionality of a point of prescription messaging application 10 of thephysician assist system 2. As will be explained in more detailed herein,generally, such application will access or control displaying ofmedication messages 21 based on medication associations 9 which relatethe messages to a medication selected for prescription.

The physician assist system 2 may also include a prescription messagingdata center server 8. The data center server 8 is also preferablyequipped with one or more communications devices for communication withone or more physician accessible prescribing devices 4 having point ofprescription applications 10. This communication between the data centerserver 8 and the physician accessible prescribing device may be director indirect. Generally, the data center server 8 will include processorcontrol instructions for communications between physician accessibleprescribing devices 4 for prescription related data exchange as will bedescribed in more detail below. Of course, the data center server 8 maybe implemented by multiple servers accessible over open and/or privateor otherwise secure networks. The database of such a prescriptionmessaging data center server 8 may include the information of a PBM orotherwise have access to a PBM over the network 6. Furthermore, thedatabase of the prescription messaging data center server 8 may alsoinclude alternative drug associations and messages associated withrecommending such alternative drugs to physicians as will be explainedin more detail herein.

In general, the physician assist system 2 may also include distributionrelated systems such as one or more servers associated with pharmacysystems 12. Generally, the pharmacy system 12 is accessible by thenetwork 6. It is preferred that the pharmacy system 12 be enabled forreceiving or processing prescription requests or orders for distributionof medication to a patient of the physician. Thus, in a typicalarrangement, the pharmacy system 12 may electronically receive aprescription over the network 6. Since this information is preferred tobe confidential, such electronic communication may be via encryptedelectronic data messaging or other secured communication such as atelephone facsimile transmission received by the pharmacy system 12.

Other arrangements of the components of such a physician assist system 2will be apparent to those skilled in the art. For example, thecomponents may be arranged as the electronic prescription systemdisclosed in U.S. patent application Ser. No. 09/653,123 filed Aug. 31,2000, the contents of which have been incorporated herein by reference.

In general, such systems will share electronic patient information anddrug/medication information as discussed herein, which may be stored invarious devices or databases of the system. Data sharing between suchsystems may be periodic as in a synchronization scheme. Such sharing mayalso be transferred by a communication means as needed when suchinformation is requested at any given time by a device of the system.

As previously discussed, the physician accessible prescribing device 2of the system when equipped for entering electronic prescriptionsincludes a point of prescription messaging application 10. A descriptionof an operation controlled by the control code of such an applicationwill now be described with respect to a preferred embodiment.

In this example of operation, a physician-prescriber operatesprescribing device 4 with the physician assist system for the purpose ofprescription generation as illustrated with regard to the user interfaceillustrations of FIGS. 3 to 22. Initially, for security purposes, alogin screen is displayed (FIG. 3) prompting the prescriber to enterlogin information. Logging in preferably includes entering logininformation which may include electronic signature and/or a handwritingsamples (FIGS. 4-6).

The prescriber then may be prompted to select a schedule of patients bythe appearance of a schedule icon (FIG. 7). With selection of theschedule icon, a patient list may be viewed for selection of aparticular patient (FIG. 8 or 9). In general, access to the patient'smedical history may be provided with this application on the prescribingdevice. Preferably, a list of medications is displayed for the patientas illustrated in FIG. 10. From such a list, the prescriber can select amedication that was prescribed to the patient, as in the example onethat contains Prozac, and view related prescription information (e.g.,date of prescription and prescribing doctor) (FIGS. 10 and 11). Suchpatient information may be accessed on the prescribing device 4, forexample, as a patient and/or prescription information files. However, ifnot, such information may be requested from the physician databasesystem 5, the prescription messaging data center 8, and/or the pharmacysystem 12.

As illustrated in FIG. 11 compliance information may also be displayedby the point of prescription messaging application 10 on the prescribingdevice 4 by activating a compliance icon CI. This activation theninitiates a display of real time prescription compliance informationsuch as the user interface illustrated in FIGS. 11A to 11E. Complianceinformation may be accessed locally based on synchronization techniquesas previously described or accessed by a request over the network 6 to apharmacy system 12, prescription messaging data center 8 and/orphysicians systems 5 storing such information.

For example, in FIG. 11A after accessing compliance information eitherstored locally or remotely, the device 10 can display complianceinformation, such as dates that prescriptions were filled, details ofthe quantity of the medication that was filled, whether or not theprescription was filled, whether a generic medication was substitutedfor a name brand, whether the previously written prescription matcheswhat was filled by the pharmacy, etc. The point of prescriptionmessaging application 10 on the prescribing device 10 may even comparefilling dates and quantities, preferably including a quantity as afunction of time, and assess whether or not a patient is taking too muchmedication or too little meditation. In one embodiment, an automatedalert to notify the prescriber may be generated as illustrated in FIG.11A where a patient prescription filling dates suggests that medicationis not being taken at the prescribed dosage level. For example, if thepatient has a day supply and then re-fills the prescription 35 daysafter the first, the comparison of dates and quantities suggests thatthe patient is not taking the medication daily as may be required. Suchan alert may be generated if the filling dates and supply are more thana certain number of days off, e.g. more than 2. Alternatively, anoveruse alert may be automatically generated where the patient isordering medication significantly faster than the prescribed supply.Such an automated alert is illustrated in FIG. 11B. While such alertsmay be generated by an automated comparison of date and supply data onthe device 10, such a comparison may be generated in another system,such as the other systems previously described (e.g., the pharmacysystem 12, prescription messaging system 8 or the physicians systems 5)and merely accessed and displayed by the device 10.

The device may inform the physician that a prescription has not beenfilled. Such an alert is illustrated in FIG. 11C. Moreover, in the eventthat the patient's filling data satisfies the dosage and supplyparameters of the point of prescription messaging application, theprescriber may be notified that the patient's use of his or hermedication is proceeding properly. This example is illustrated in FIG.11D. FIG. 11E illustrates a warning message based on a comparison of thewritten prescription and the filled prescription indicating adiscrepancy. A message indicating a correctly filled prescription mayalso be displayed in case of a properly filled prescription. Such acomparison may check dosage/quantity information, medication type,medication name or brand, usage instructions, etc.

With such compliance information, the prescriber or physician cancontact the patient to determine if any problems exist, otherwiseexplore with the patient compliance issues or correct an error infilling the prescription. The physician may also better understand why apatient's condition may or may not be improving and attribute it tocompliance or not as suggested by the point of prescription messagingapplication and prescribing device.

As illustrated in FIG. 12 a list of available forms of the selectedmedication Prozac may be displayed. From the list, a specific medicationmay be selected (10 mg capsule oral). In further response to selection,drug information is displayed as illustrated in FIG. 13. Such druginformation may be accessed on the prescribing device 4, for example, asa drug information files. However, if not, such information mayrequested from the physician database system 5, the prescriptionmessaging data center 8, and/or the pharmacy system 12.

The prescriber may also return to again view the list of medications forthe patient as illustrated in FIG. 14. The prescriber then may selectanother medication, (e.g. Ritalin 10 mg). AS illustrated in FIG. 15,such selection may be followed by conducting a DUR (“drug utilizationreview”) alert which is displayed if the prescriber proceeds inselecting that medication (“DUR Alert—Severe Alert”). Examples of suchalerts are illustrated in FIGS. 15, 16 and 17. Of course, such an alertmay be based on data currently or previously requested from a PBM overthe network.

Additionally, the point of prescription messaging application 10 isconfigured with the control instructions for generating display ofmedication messages 21 suggesting one or more alternative medication(s)associated with a medication selection made on the prescribing device 4.In this regard, alternative medication suggestions 20 may be accompaniedby a sponsor information message 22. Such messages may be based on data(e.g., associations between medications and alternative medications fromdifferent sponsors, and sponsor messages) stored on the prescribingdevice 4 or transferred from prescription messaging data center 8 as aresult of a request based on the selection of the original medication orotherwise.

For example, as illustrated in FIGS. 18 and 19, if the prescriberproceeds in selecting Ritalin, point of prescribing messages aredisplayed if that medication has an association with alternativemedications of a different sponsor. Thus, an alternative medicationsuggestions 20 sponsored by a maker of another medication may bedisplayed. The sponsor, seller or maker can define any number of suchmessages for one or more alternative medications. When such a message islaunched, multiple messages can be cycled in the display of theprescribing device 4 according to a predetermined sequence such that adetailed presentation may be provided about the alternative medication.

In the illustrated example, the messages are generated in response toRitalin selection. In response, a different medication (Metadate) issuggested for treating the same condition in a suggested medicationlist. Moreover, an alternative medication message 22 suggesting theprescription of an alternative medication is displayed based on theprescriber selecting the particular medication. This message illustratesproviding information to the prescriber on contacting the source of thealternative medication (e.g., the sponsor, seller or maker of thealternative medication), for example, to find out information about themedication. The message may also suggest one or more “SIG”(s) (i.e.,doses and/or usage instructions related to prescribing the alternativesuggested medication (e.g., “take one tablet (20 mg) by oral route oncea day before bedtime”). Such dose and usage instruction messages areillustrated in the user interface of FIG. 20. The prescriber may selecta suggested dose and usage instruction, use a default suggested dose andusage instruction or create a custom one that can then be incorporatedinto a prescription.

Stated another way, the originally selected medication provides a‘trigger’ for displaying a message suggesting an alternative ‘target’medication. While alternative medications or messages of a sponsorcommon to the trigger medication may be displayed, the display ofmessages suggesting the alternative medication is typically based on thesuggested medications of a different sponsor or maker. Such messagesoffer a way for sponsored promotion of other brand name medications tothe prescriber as an alternative to the selected brand name or genericmedication at the point of prescription.

Typically, an electronically stored table or other database type datastructure is used to relate or associate the trigger medications totarget medications. Preferably, information about each medication isstored and displayed by a drug name, a strength, a dose form, and aroute of administration; e.g., Ritalin 10 mg Tablet (Oral)). Of course,complete medical information concerning the drug may also be accessed orview with the prescribing device 4. When the prescriber selects amedication on the prescribing device, the table is consultedelectronically in response thereto either locally or via communicationssuch as over the network 6. If the medication is a trigger medication, amessage suggesting the target medication is then displayed.

One such table is shown for purposes of illustration in FIG. 23. Thoseskilled in the art will recognize other data structures and programmingtechniques for implementing a display of messages based on alternativemedication suggestions as discussed herein. In the illustrated table,selected Medication-A offered or made by Sponsor-A has six possiblealternatives associated with it. These include Medication-B,Medication-BB, Medication-BBB, each from Sponsor B. Alternativemedications labeled Medication-C and Medication-CC are sponsored bydifferent Sponsor-C and are also associated as alternatives ofMedication-A. Finally, alternative Medication-AA of Sponsor A is also analternative of Medication-A. Such alternatives and their associations asrepresented by the table structure would be previously determined basedon the medical information associated with the medications if suchmedications are equivalently used for a particular patient diagnosissuch that either one may be selected. However, such associations neednot strictly be intended for alternative use but may indicate use inconjunction with the originally selected medication to the extent thatthey relate to a common patient diagnosis. Optionally, the associationsmay simply be based on associations specified by a particular sponsor,maker or seller of such targeted medications without relation as analternative drug equivalence or any relationship to a given diagnosisfor a patient.

In a preferred embodiment, the table optionally includes additional datacondition(s) (one or more) that help to determine whether anyalternatives will be displayed in response to the medication selectionand the content of such message. Thus, in response to the selection, thetable is checked to determine if one or more alternative medicationsshould be displayed based on the association between the trigger andtarget medications as well as any additional preset condition(s). Forexample, the table may include conditions based on the age and/or genderof the patient. In such a case, when the trigger medication is selectedby the prescriber, the particular target medication displayed can differbased on the patient's age and/or gender.

An example of such a table is illustrated in FIG. 24 with sampleconditions based on age and gender. Thus, for a female patient based onthe existing hypothetical table example, if a Medication-A is selected,Medication-C would not be suggested. If the female patient was over 18years of age, Medication-BB would also not be suggested. Thus, for thispatient, of the six associated medications, only the remaining fourwould be displayed (i.e., Medication-B, Medication-BBB, Medication-CC,and Medication-AA).

Other embodiments of the system may include other conditions or factorscontrolling the display of alternative suggested medications (targets).For example, display of a particular message or suggestion of aparticular target medication can be conditioned on the location of theprescriber or patient, e.g., location within a particular region of theUnited States such as Northeast, Southeast, Midwest, state, county,town, etc. Thus, for the above example, if the female, over 18 patientwas in a Northern region, upon selection of Medication-A, Medication-Cand Medication-CC would be excluded. Thus, only Medication-B andMedication-BBB would be displayed as suggested alternatives.

Finally, a date condition may also be applied, for example, based onwhen an insurance plan, sponsor or maker intends to phase out or phasein a medication. Similarly, such a date filter may simply relate to aparticular period of time that a sponsor desires to have its medicationssuggested as alternatives. Thus, with regard to additionally applying adate filter or condition to the above example, if the selection by theprescriber was being made for after Jan. 1, 2001, Medication-BBB wouldbe excluded and only Medication-B would be suggested as the target forthe prescriber's selection of Medication-A.

In this way, the display of alternative suggested medications may befiltered by various conditions to save the physician time from selectinga suggested medication for the patient that would not be appropriate andwould have to be subsequently changed after it is discovered that it wasan inappropriate selection for any given reason. The system may also beimplemented to maximize the presenting of education information pursuantto a desired set of conditions specified or desired by a sponsor. Whilethe illustrated filtering conditions of FIG. 24 include age, gender,region and date, other conditions for filtering suggested medications,for example, such as a sponsor or maker condition, may be implemented.Thus, the application may control restricting any sponsor fromdesignating a trigger medication for more than one group of targetmedications or only the display of a single sponsor's alternativemedication suggestions may be implemented. Similarly, the samemedication may be controlled such that it cannot be a trigger for morethan one sponsor in any designated region.

Optionally, additional control conditions or rules for displayingassociated alternative medications may include a set maximum number oftimes to show messages to a particular physician for a group of targetmedications. The application may also control how frequently to triggera message. For example, the message for any given alternative may beshown every time a trigger medication is selected, every other time,every third time, etc. Preferably, a message will not be triggered morethan once for a single prescription.

Furthermore, such conditions in determining whether the display of atarget or alternative medication in response to selection of a triggermedication may additionally be based on other patient information suchas first, second, third, etc. diagnoses data of the patient such as ifthe target medication would be inappropriate or appropriate for one ormore of such diagnoses which may or may not be common with a diagnosisfor which the trigger medication was selected. In this event, medicationor drug related data with regard to the particular diagnoses for whichthe suggested medication is prescribable would be compared to thepatient's actual diagnoses.

Subsequently, with the presented alternative suggested medication,filtered by these conditions or otherwise, the prescriber may choose toprescribe a presented target medication. This selected medication, aswith the original trigger medication, may also be automaticallysubjected to an electronic DUR for checking for conflicts with thepatient's history or the patient's insurance plan on the prescribingdevice 4 and informing the physician of the results. In this event,patient name, social security data, address or other patient identifierinformation may be used when checking the medication. However, the DURand formulary requirements may also alternatively be implemented asconditions restricting the display of an alternative medicationsuggestion or target medication if it would not satisfy the DUR orformulary restrictions of the patient and plan, thus, preventing theprescriber from reviewing the suggested medication if it did not satisfythe DUR and formulary requirements. This may be achieved by automatedremote access to PBM information over the network 6 or by automatedaccess to previously stored information on the prescribing device 4.

Of course, the prescriber may disregard the alternatives suggested andprescribe the original selected trigger drug. The prescriber may evendelete or cancel the selected original drug, select a presentedalternative target medication which is not equivalent to the original aswell as selecting another alternative target medication which isequivalent to the original selected medication. As illustrated in theexample shown in FIGS. 19, 20 and 21, upon selecting the alternativesuggested medication and the prescriber may proceed to generate anelectronic prescription. As illustrated in FIG. 22, the prescriptionprocess may be completed by using the application to initiate a transferof the created electronic prescription to a pharmacy system 12 over thenetwork 6.

Thus, the resulting prescriptions are automatically sent to a patient'spharmacy with a simple click of a button via secure communication suchas via a fax telephone line. Prescriptions can also be printed for chartcopies or for patients. Because the prescriber's signature is capturedat the session login, it can appear on all prescription scripts writtenduring that session.

Optionally, the point of prescription messaging application 10 may alsocontrol tracking of information associated with targeted medicationsuggestions. For example, for each physician in a practice or based on agroup of physicians of a practice, the application can record the numberof times a message was triggered for any targeted medications. Forprescribed targeted medications, it may also record whether or not thetarget medication was chosen as a result or in connection with thedisplay of a triggered message, and, if so, which message was displayed.This tracking of data may also include monitoring of which medicationwas originally chosen, as well as the DUR and formulary status of boththe original triggered medication and the target medication for purposesof future comparison.

Sponsors can benefit from providing targeted messages that offeralternative drugs at the point of prescribing. Physicians and patientsbenefit when the prescriber or physician selects a designated triggermedication because a sponsor-defined point-of-prescribing message isdisplayed that will identifying the sponsor and educate the physician onone or more beneficial alternatives to the medication selected.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

The invention claimed is:
 1. A computer-implemented method comprising:prompting, via a user interface of a device, a prescriber to enter anelectronic handwriting sample during a login process; receiving, via auser interface, a first selection, the first selection comprising aselection of a first medication in relation to a patient; receiving,from a sponsor, one or more conditions that reflect one or morescenarios in which one or more messages associated with an alternativemedication are to be provided, the one or more conditions comprising adetermination whether the alternative medication is appropriate orinappropriate for a second diagnosis with respect to the patient whichmay or may not be common with a first diagnosis with respect to thepatient, wherein the first selection is received with respect to thefirst diagnosis; synchronizing, via an encrypted communicationinterface, information relating to the patient that is stored in aphysician-accessible database with information relating to the patientthat is stored in a pharmacy database; activating a compliance iconwithin the user interface for accepting selections for inclusion in anelectronic prescription; determining, in response to an activation ofthe compliance icon, in relation to the first medication, and in view ofa synchronization of the information relating to the patient that isstored in a physician-accessible database with information relating tothe patient that is stored in a pharmacy database, real timeprescription compliance data for the patient, the real time prescriptioncompliance data comprising data reflecting a degree of compliance by thepatient with a prescription of the first medication; generating, by aprocessor and based on the prescription compliance data and a locationof the patient, a predetermined sequence of one or more messages, theone or more messages comprising information pertaining to an alternativemedication suggested with respect to the patient; receiving a secondselection, the second selection comprising a selection of at least oneof the first medication or the alternative medication in relation to thepatient; generating, by a prescription generator and based on the secondselection, a prescription in relation to the patient; and transferringthe prescription to a pharmacy system via an encrypted communicationinterface.
 2. The method of claim 1 wherein the prescription compliancedata comprises a filling date and quantity of the first medication. 3.The method of claim 1 wherein the prescription compliance data comprisesa quantity of the first medication as a function of time since theprescription was filled.
 4. The method of claim 1, further comprisinggenerating an alert based on the prescription compliance data.
 5. Themethod of claim 4 wherein the alert is generated based on adetermination that the patient is not taking the first medication asinstructed.
 6. The method of claim 4, wherein the alert is generatedbased on a determination the patient is overusing the medication.
 7. Acomputer-implemented method comprising: prompting, via a user interfaceof a device, a prescriber to enter an electronic handwriting sampleduring a login process; receiving, via a user interface, a firstselection, the first selection comprising a selection of a firstmedication in relation to a patient; receiving, from a sponsor, one ormore conditions that reflect one or more scenarios in which one or moremessages associated with an alternative medication are to be provided,the one or more conditions comprising a determination whether thealternative medication is appropriate or inappropriate for a seconddiagnosis with respect to the patient which may or may not be commonwith a first diagnosis with respect to the patient, wherein the firstselection is received with respect to the first diagnosis;synchronizing, via an encrypted communication interface, informationrelating to the patient that is stored in a physician-accessibledatabase with information relating to the patient that is stored in apharmacy database; activating a compliance icon within the userinterface; determining, in response to an activation of the complianceicon for accepting selections for inclusion in an electronicprescription, in relation to the first medication and in view of asynchronization of the information relating to the patient that isstored in a physician-accessible database with information relating tothe patient that is stored in a pharmacy database, real timeprescription compliance data for the patient, the real time prescriptioncompliance data comprising data reflecting a degree of compliance by thepatient with a prescription of the first medication; generating an alertbased on the prescription compliance data, the alert indicating that thepatient is not complying with one or more instruction associated withthe first medication; generating, by a processor and based on theprescription compliance data and a location of the patient, apredetermined sequence of one or more messages, the one or more messagescomprising information pertaining to an alternative medication, thealternative medication (a) being associated with the first medicationand (b) being an alternative to the first medication with respect adiagnosis associated with the patient; receiving a second selection, thesecond selection comprising a selection of at least one of the firstmedication or the alternative medication in relation to the patient;generating, by a prescription generator and based on the secondselection, a prescription in relation to the patient; and transferringthe prescription to a pharmacy system via an encrypted communicationinterface.
 8. The method of claim 7 wherein the prescription compliancedata comprises a filling date and quantity of the first medication. 9.The method of claim 8 wherein the prescription compliance data furthercomprises a quantity of the first medication as a function of time sincethe prescription was filled.
 10. The method of claim 7 wherein theinformation pertaining to the alternative medication comprises at leastone of (a) dosage information or (b) usage instructions pertaining tothe alternative medication.
 11. A system comprising: a memory; and aprocessor, coupled to the memory, to: prompt, via a user interface of adevice, a prescriber to enter an electronic handwriting sample during alogin process; receive, via a user interface, a first selection, thefirst selection comprising a selection of a first medication in relationto a patient; receive, from a sponsor, one or more conditions thatreflect one or more scenarios in which one or more messages associatedwith an alternative medication are to be provided, the one or moreconditions comprising a determination whether the alternative medicationis appropriate or inappropriate for a second diagnosis with respect tothe patient which may or may not be common with a first diagnosis withrespect to the patient, wherein the first selection is received withrespect to the first diagnosis; synchronize, via an encryptedcommunication interface, information relating to the patient that isstored in a physician-accessible database with information relating tothe patient that is stored in a pharmacy database; activate a complianceicon within the user interface; determine, in response to an activationof the compliance icon for accepting selections for inclusion in anelectronic prescription, in relation to the first medication and in viewof a synchronization of the information relating to the patient that isstored in a physician-accessible database with information relating tothe patient that is stored in a pharmacy database, real timeprescription compliance data for the patient, the real time prescriptioncompliance data comprising data reflecting a degree of compliance by thepatient with a prescription of the first medication; generate, based onthe prescription compliance data, a predetermined sequence of one ormore messages, the one or more messages comprising informationpertaining to an alternative medication, the alternative medicationbeing associated with the first medication as a suggested alternative tothe first medication; receive a second selection, the second selectioncomprising a selection of at least one of the first medication or thealternative medication in relation to the patient; generate, by aprescription generator and based on the second selection, a prescriptionin relation to the patient; and transferring the prescription to apharmacy system via an encrypted communication interface.
 12. The systemof claim 11 wherein the prescription compliance data comprises a fillingdate and quantity of the first medication.
 13. The system of claim 12wherein the prescription compliance data further comprises a quantity ofthe first medication as a function of time since the prescription wasfilled.
 14. The system of claim 11 wherein the processor is further togenerate an alert based on a determination that the patient is nottaking the first medication as instructed.
 15. The system of claim 14wherein the alert is generated based on a determination that the patientis not taking the first medication as instructed.
 16. The system ofclaim 11 wherein the alert is generated based on a determination thepatient is overusing the medication.
 17. The method of claim 1, whereingenerating one or more messages comprises generating one or moremessages based on the prescription compliance data, the one or moremessages comprising information pertaining to an alternative medication,the alternative medication (a) being associated with the firstmedication and (b) being an alternative to the first medication withrespect a diagnosis associated with the patient.
 18. The method of claim1, wherein generating one or more messages comprises generating, basedon the prescription compliance data, one or more messages, the one ormore messages comprising information pertaining to an alternativemedication, the information pertaining to an alternative medicationcomprising at least one of (a) dosage information or (b) usageinstructions pertaining to the alternative medication.
 19. The system ofclaim 11, wherein to generate one or more messages is to generate one ormore messages based on the prescription compliance data, the one or moremessages comprising information pertaining to an alternative medication,the alternative medication (a) being associated with the firstmedication and (b) being an alternative to the first medication withrespect a diagnosis associated with the patient.
 20. The system of claim11, wherein to generate one or more messages is to generate, based onthe prescription compliance data, one or more messages, the one or moremessages comprising information pertaining to an alternative medication,the information pertaining to an alternative medication comprising atleast one of (a) dosage information or (b) usage instructions pertainingto the alternative medication.